Promoting Responsive Bottle-Feeding Within WIC: Evaluation of a Policy, Systems, and Environmental Change Approach

Abstract

Background Bottle-fed infants are at greater risk for overfeeding and rapid weight gain (RWG); evidence-based strategies for promoting healthy bottle-feeding practices are needed.Objective Our aim was to assess whether policy, systems, and environmental (PSE) strategies for promoting responsive bottle-feeding practices within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were associated with lower risk for RWG.Design We conducted a matched-pair cluster randomized trial. PSE strategies were implemented at 3 WIC clinics in Los Angeles County. PSE clinics were compared with 3 matched control clinics. Mothers and infants were assessed when infants were newborn and 3 months and 6 months of age.Participants/setting Participants were mothers (n ¼ 246) who enrolled their newborn infants (younger than 60 days) into WIC between May and August 2019.Main outcome measures Infant weight was assessed and standardized to sex-and age-specific z scores. RWG was defined as weight-for-age z score change > 0.67. Mothers completed questionnaires assessing responsive and pressuring feeding styles, breastand bottle-feeding patterns, and perceptions of WIC experiences. Statistical analyses performed Logistic regression with estimation via generalizedestimating equations and linear mixed models with repeated measures assessed effects of PSE strategies on categorical and continuous outcomes, respectively.Results Infants in PSE clinics had significantly lower likelihood of exhibiting RWG (P ¼ .014) than infants in control clinics. Mothers in PSE and control clinics reported similar levels of responsive and pressuring feeding style and similar prevalence of breastfeeding and bottle-feeding. Mothers in PSE clinics trended toward feeling better supported with respect to their decision to bottle-feed (P ¼ .098) and had more stable intentions to stay in the WIC program (P ¼ .002) compared with mothers in control clinics.Conclusions PSE strategies focused on promoting more inclusive assessment of infant feeding, tailored bottle-feeding counseling, and increased education and support for responsive bottle-feeding were associated with lower risk for RWG among WIC infants.

WIC Participants’ Perceptions of COVID-19-Related Changes to WIC Recertification and Service Delivery

“…Participants included mothers and infants who participated in a PSE intervention between June 2019 and August 2020. For more details see Ventura et al [5]. In brief, three WIC clinics were selected to be the clinics within which PSE strategies to support healthy bottle-feeding were implemented (PSE clinics) and three WIC clinics were selected as controls; control clinics were matched to PSE clinics based on WIC participant race/ethnicity, clinic size, and prevalence of breastfeeding.…”

Interventions Targeting Bottle and Formula Feeding in the Prevention and Treatment of Early Childhood Caries, Overweight and Obesity: An Integrative Review

“…Eighteen studies were targeted at populations with a specific vulnerability to increased overweight or obesity through infant formula use, dental caries from prolonged infant bottle use, or both: five studies targeted parents or carers in the USA WIC program [ 28 , 29 , 30 , 31 , 32 , 33 ]; four studies targeted American, Australian and Canadian First Nations communities [ 34 , 35 , 36 , 37 , 38 , 39 , 40 ]; four studies were undertaken in communities with social deprivation [ 41 , 42 , 43 , 44 ] and five studies were undertaken with cultural groups that report high prevalence of ECC [ 45 , 46 , 47 , 48 , 49 ]. The remaining nine studies targeted parents or carers of infants fed with formula [ 50 , 51 , 52 ], general populations attending well-child checks [ 53 , 54 , 55 ] or communities where the prevalence of ECC was reported to be increasing [ 56 , 57 , 58 ].…”

“…Infants and young children as the focus populations of interventions ranged from prenatal parental education [ 34 , 38 , 39 , 40 ] to 5 years of age [ 47 ]. Most interventions targeted parents as the primary carer [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 57 , 58 ]. Five interventions included extended caretakers, such as grandparents, siblings and babysitters [ 34 , 35 , 36 , 37 , 47 , 49 ].…”

“…The studies were undertaken in primary healthcare or community settings or a combination of both. Five WIC-based interventions were implemented during well-child visits or nutrition education classes [ 28 , 29 , 30 , 31 , 32 , 33 ]. Fourteen studies were undertaken during well-child visits, health visits or vaccination clinics, with physicians, nurses, health visitor (a registered nurse or midwife qualified in public health nursing in the UK [ 59 ]), dental healthcare providers and community health workers as interventionists [ 34 , 41 , 42 , 43 , 45 , 46 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ].…”

“…Lawrence and colleagues found lower rates of carer ever using bottles for feeding but no difference in the rates of breastfeeding and no difference in the prevalence of continued bottle use at 2-5 years of age [34]. Ventura and colleagues found that, although exclusive breastfeeding decreased, mixed formula feeding and breastfeeding decreased, and exclusive formula feeding increased from birth to six months; there was no interaction between responsive bottle-feeding intervention strategies and time, indicating that the intervention strategies did not inadvertently promote greater levels of bottle feeding [33]. Bottle use during sleep is a risk factor for dental caries.…”